Arterial Stiffness Intercostal Muscle Oxygenation and Aerobic-Anaerobic Capacity in Elite American Football Players

American football is a sport that demands strength, speed, courage, teamwork, and tactical intelligence, and is played with three units-offense, defense, and special teams-over four quarters of 15 minutes each. Beyond technical and tactical training, aerobic and anaerobic power, speed, endurance, body composition, flexibility, coordination, and motor skills are fundamental contributors to performance. From a mechanical perspective, American football is classified as a moderate-dynamic, moderate-static sport, while metabolically it is predominantly anaerobic. Regular physical training plays a critical role in both the prevention and management of cardiovascular disease. Arterial stiffness is an established biomarker of vascular health and an independent determinant of cardiovascular risk. Although the term refers broadly to reduced elasticity, increased rigidity, or diminished distensibility of the arterial wall, all reflect impaired vascular compliance. Progressive arterial stiffening fosters a vicious cycle: rising aortic pressure accelerates vascular damage, promotes left ventricular hypertrophy, increases myocardial oxygen demand, and disrupts diastolic function. Research examining aortic impedance suggests that age-related increases in arterial stiffness occur more slowly in individuals who engage in lifelong regular exercise, although changes that emerge later in life may be irreversible.

Acute aerobic exercise has been shown to transiently improve arterial compliance, with increases of up to 30-40%, returning to baseline approximately one hour after exercise due to enhanced vasodilation. Studies evaluating athletes' brachial and central blood pressure and pulse wave velocity indicate that high-performance sport does not adversely affect arterial stiffness, and proposed reference values may support more detailed cardiovascular and hemodynamic assessment in elite athletic populations. Notably, no studies have specifically examined arterial stiffness in elite American football players. Based on existing evidence, it is anticipated that these athletes will exhibit lower arterial stiffness than sedentary individuals, suggesting reduced cardiovascular risk-a finding that may help identify at-risk groups more accurately.

Assessment of muscle oxygen metabolism in athletes is also crucial. During high-intensity competition, increased ventilatory demand can reduce blood flow to locomotor muscles, contributing to exercise intolerance and premature fatigue. Intercostal muscle oxygenation has been shown to be closely associated with peak oxygen uptake in athletes. As ventilation increases, the metabolic cost of breathing and oxygen consumption rise, elevating the respiratory muscles' oxygen requirements. The ability to adequately deliver oxygen to these muscles is therefore functionally important and merits investigation. However, no studies to date have evaluated intercostal muscle oxygenation in American football players.

Although several studies have explored physical and physiological characteristics across various sports, research specifically examining athletes engaged in American football-particularly in Türkiye, where the sport is expanding at the university level-remains limited. In prolonged athletic activity, maximal oxygen uptake (VO₂max) is a critical determinant of performance, reflecting the capacity to transport oxygen from inspired air to skeletal muscle mitochondria. At exercise intensities beyond the point at which cardiac output plateaus, the respiratory system must work disproportionately harder to maintain oxygen delivery to active tissues. VO₂max fundamentally represents the oxidative capacity of skeletal muscle mitochondria; higher values support the ability to sustain exercise for longer durations under stable physiological conditions. Aerobic capacity therefore depends on the integrated function of pulmonary, cardiovascular, hematologic, and muscular oxidative systems.

Anaerobic performance also plays a key role in sports requiring high-intensity, short-duration exertion. Energy for such activities is provided primarily through phosphagen and glycolytic pathways, which generate ATP rapidly but in limited quantities, whereas aerobic metabolism produces ATP at a slower rate but with virtually unlimited capacity. The phosphagen system supports explosive movements lasting up to approximately 15 seconds; activities lasting 15-30 seconds rely on both phosphagen and glycolytic pathways; and efforts of around 30 seconds depend almost entirely on glycolysis. Anaerobic performance varies according to individual and environmental factors, but regular training enhances these systems significantly. Athletes with higher anaerobic capacities typically exhibit greater fast-twitch muscle fiber content, larger muscle cross-sectional area, and superior muscle strength-factors that contribute to essential performance attributes such as sprinting and explosive lower-limb force.

Despite the central role of these physiological determinants, no research has examined arterial stiffness in elite American football players, and studies evaluating intercostal muscle oxygenation as well as aerobic and anaerobic capacities in this population are scarce. Therefore, the present study aims to evaluate arterial stiffness, intercostal muscle oxygenation, and aerobic and anaerobic exercise capacity in elite American football players and to compare these outcomes with those of sedentary individuals.

Inclusion criteria

for the elite American football group :

• Being a male athlete aged 18-30 years
• Volunteering to participate

Exclusion criteria

for the elite American football group:

• Having any acute infection, orthopedic, neurological, or sensory problems (hearing, vision, or cooperation difficulties) that could interfere with measurements
• A history of smoking
• A history of alcohol consumption
• A history of COVID-19 infection
• Use of medications or antioxidant supplements

Inclusion criteria

for the sedentary group

• Being a male aged 18-30 years
• Volunteering to participate

Exclusion criteria

for the sedentary group

• Included any acute, orthopedic, neurological, or sensory condition that might interfere with the assessments
• Having a regular exercise habit